可溶性凝集素样氧化型低密度脂蛋白受体-1在急性缺血性脑卒中表达及与静脉溶栓预后和静脉溶栓后脑出血转化的关系

Expression of soluble lectin-like oxidized low-density lipoprotein receptor-1 in AIS and its relationship with the prognosis of intravenous thrombolysis and cerebral hemorrhage transformation after intravenous thrombolysis

目的探讨可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)在急性缺血性脑卒中(AIS)表达及与静脉溶栓预后和静脉溶栓后脑出血转化的关系。方法选取2017年3月至2020年6月南京市高淳人民医院AIS病人104例,酶联免疫吸附法(ELISA)法测定血清sLOX-1水平,比较sLOX-1表达高低与病人临床资料的关系,分析sLOX-1与AIS病人静脉溶栓预后和静脉溶栓后脑出血转化的关系。结果相比于低sLOX-1表达组,高sLOX-1表达组病症更加严重,美国国立卫生院卒中量表(NHISS)评分显著增大,白细胞显著升高,肾小球滤过率估算值(eGFR)、尿酸(UA)显著降低(均P<0.05);行重组组织型纤溶酶原(rt-PA)静脉溶栓治疗预后不良组sLOX-1表达显著高于预后良好组[(2.18±0.71)比(1.67±0.53)];多因素logistic回归模型结果发现经过年龄、溶栓时间、NHISS评分、eGFR等校正过后,sLOX-1[OR=3.83,95%CI:(1.77,5.12),P=0.007]仍然是行rt-PA静脉溶栓AIS病人预后的独立危险因素,经过年龄、NHISS评分、溶栓时间等校正过后,sLOX-1[OR=1.84,95%CI:(1.12,2.54),P=0.020]也仍然是AIS病人发生脑出血性转化(HT)的独立危险因素。结论血清sLOX-1是行rt-PA静脉溶栓AIS病人预后的独立危险因素,也是AIS病人发生脑HT的独立危险因素。

Objective To explore the expression of soluble lectin-like oxidized low-density lipoprotein receptor-1(sLOX-1)in acute ischemic stroke(AIS)and its relationship with the prognosis of intravenous thrombolysis and cerebral hemorrhage transformation after intravenous thrombolysis.Methods A total of 104 patients with AIS in Nanjing Gaochun People's Hospital from March 2017 to June 2020 were selected,and serum sLOX-1 levels were measured by enzyme-linked immunosorbent assay(ELISA).The relationship between high and low sLOX-1 expression and patients'clinical data was compared,and the relationship between sLOX-1 and the prognosis of intravenous thrombolysis and transformation of cerebral hemorrhage after intravenous thrombolysis in patients with AIS was analyzed.Results Compared with the low sLOX-1 expression group,the high sLOX-1 expression group had more severe disease,with significantly larger National Institutes of Health Stroke Scale(NHISS)scores,significantly higher white blood cells,and significantly lower estimated glomerular filtration rate(eGFR)and uric acid(UA)(P<0.05).sLOX-1 expression was significantly higher in the poor prognosis group treated with recombinant tissue-type fibrinogen(rt-PA)intravenous thrombolysis than in the good prognosis group[(2.18±0.71)vs.(1.67±0.53)].The results of the multivariate logistic regression model revealed that sLOX-1[OR=3.83,95%CI:(1.77,5.12),P=0.007]remained an independent risk factor for prognosis in patients with AIS undergoing rt-PA intravenous thrombolysis after correction for age,time to thrombolysis,NIHSS score,and eGFR.After adjustment for age,NIHSS score and thrombolysis time,sLOX-1[OR=1.84,95%CI:(1.12,2.54),P=0.020]also remained an independent risk factor for cerebral hemorrhagic transformation(HT)in patients with AIS.Conclusion Serum sLOX-1 is an independent risk predictor for the prognosis of AIS patients undergoing rt-PA intravenous thrombolysis and an independent risk factor for the development of cerebral HT in AIS patients.